GPs 'ready for rapid change' over next three years, MPs told

GPs will embrace rapid change in the next 24 to 36 months because their 'backs are against the wall' after years of underfunding, the NHS England chief executive told MPs on Monday.

The profession ‘wants the cavalry to arrive now’, and NHS England’s job is to make that happen, Simon Stevens said in evidence to the House of Commons public accounts committee.

Giving evidence to an inquiry into access to primary care, the NHS chief told MPs that general practice needs to deliver a more coherent, but ‘more differentiated’ offer than the one-size-fits-all approach offered by the existing national GP contract.

In an earlier evidence session with the committee, RCGP chairwoman Dr Maureen Baker told MPs that GPs were demoralised after a failure to invest in the service over a decade and by constant ‘GP bashing’ in the media. The RCGP chair hit out at the ‘mismatch’ between the GP workforce and rising demand, and criticised bureaucracy that makes it difficult for doctors to return to the workforce after spells abroad.

GP access

MPs challenged witnesses to explain why satisfaction with access to GP services was in decline. GPonline reported this month that GPs had maintained high levels of patient satisfaction despite a steady decline in satisfaction in the face of rising pressure over the past five years.

Mr Stevens told MPs: ‘The nub of the matter is that demands on general practice have been going up and the relative resourcing has not kept pace with that.’

The NHS England chief executive said work to change the clinical, business and career model of general practice was ‘at best unfinished business’.

‘But because people’s backs are against the walls, they are prepared to consider doing things quite differently in primary care. And if we can provide the support and resourcing for that we can see quite substantial change over the next 24 to 36 months,’ he told MPs.

Mr Stevens said ‘simplifying, bringing coherence to the primary and community care piece’ was the key task for his organisation over the next two or three years.

New models of care

Looking at primary care, he said the lesson from the past decade was that ‘we have to be more differentiated in our offer’.

‘We have had one-size-fits-all solutions in the national contract, not sufficiently sensitive to different geographies or starting points around the country. And layered on top of that individual initiatives, funding streams - each had their own logic but when you turn up in Leicester or Manchester or Swindon and say: "What does it mean for this community?", you have all these legacy initiatives running side by side, to an extent cancelling each other out - not getting best value for the money, and it’s not working from GPs’ point of view.’

Dr Baker told MPs that numbers of GPs had not kept pace with the rising complexity of work in primary care and rising demand. She added that there was no mechanism to encourage GPs to work in deprived areas, and that although many doctors still chose to work in those areas, they were worst-hit by the workforce shortage.

The 10-point workforce plan that both NHS England, the RCGP and others are working on aimed to encourage doctors into areas with greater deprivation, she said.

Witnesses to the inquiry called for more data collection in general practice to assess workload, and said that work was underway to better understand the factors driving GPs to retire early.

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